Local drug delivery injection catheter daryush mirzaee

ABSTRACT

A catheter for injecting medication to a specific point within a patient comprises a drug delivery lumen extending from a proximal end of the catheter to an injection port. The catheter comprises a mechanism for angularly pushing the injection port outwardly away from the body of the catheter into an artery wall so that medication can be injected directly into the artery wall.

BACKGROUND OF THE INVENTION

[0001] This invention pertains to a catheter for delivering a drug to a specific location within a patient's artery.

[0002] It is known in the art to provide catheters for delivering drugs directly into the walls of a patient's artery. An example of such a catheter is described in U.S. Pat. No. 5,746,716, issued to Vigil et al. Vigil's catheter 1 includes a set of injectors 2 for injecting medication into an artery wall 3 (FIG. 1). Injectors 2 are mounted on a balloon 4 which is inflated when it is desired to push injectors 2 into artery wall 3. Unfortunately, injectors 2 extend in a direction perpendicular to the axis of catheter 1. Thus, when catheter 1 is inserted or withdrawn from the patient's vascular system, there is a danger that injectors 2 will drag along and injure artery wall 3.

[0003] What is needed is an improved catheter which permits delivery of a drug into the walls of an artery where the drug is believed to be most effective.

[0004] What is also needed is a catheter with injectors which will not drag across the artery walls when the catheter is inserted or withdrawn from a patient.

SUMMARY

[0005] A catheter in accordance with an embodiment of the invention comprises an injection port at or near the distal end thereof and a mechanism for directing the injection port angularly away from the central axis of the catheter and into the artery wall. (An injection port is a structure used for introducing medication or other material into a patient. The injection port typically is a hollow needle.) In one embodiment, the catheter includes a guide wire lumen for receiving a guide wire that enables a physician to direct the catheter to a desired location within the patient's vascular system. Also, in one embodiment, the catheter includes a plurality of needles, each of which may be manipulated at an angle outwardly from the central longitudinal axis of the catheter so that the needles can inject a drug or medication into the surrounding tissue. Prior to deployment of the needles, the needles are retained such that they lie substantially parallel to the longitudinal axis of the catheter.

[0006] In one embodiment, a balloon is provided towards the distal end of the catheter for pushing the needles outwardly into the artery wall. In another embodiment, other mechanical means are provided for pushing the needles outwardly.

[0007] These and other features of the invention are described below.

BRIEF DESCRIPTION OF THE DRAWINGS

[0008]FIG. 1 illustrates a prior art catheter for injecting medication into a patient's artery walls.

[0009]FIG. 2 illustrates in cross section a catheter constructed in accordance with the invention comprising needles for injecting medication into an artery wall.

[0010]FIG. 3 illustrates in cross section the catheter of FIG. 2 in which the needles are extended outwardly for injecting medication into the artery wall.

[0011]FIG. 3′ illustrates an enlarged portion of the catheter of FIG. 3.

[0012]FIG. 3A illustrates in cross section the catheter of FIGS. 2 and 3 along lines A-A.

[0013]FIG. 3B illustrates in cross section an alternative embodiment of a catheter along lines A-A in which a stiffening mandrel is provided external to two of the catheter tubes.

[0014]FIG. 3C illustrates a cut formed in a tube to accommodate placement of a needle.

[0015]FIG. 3D illustrates another cut formed in a tube to accommodate placement of a needle.

[0016]FIG. 4 illustrates another embodiment of a catheter including a balloon for pushing needles from the catheter outwardly into the artery wall.

[0017]FIGS. 4A, 4B and 4C illustrate in cross section the catheter of FIG. 4 along lines A-A, B-B and C-C, respectively.

[0018]FIG. 4D illustrates in cross section an alternative balloon used in conjunction with another embodiment of a catheter in accordance with the invention.

[0019]FIG. 4E illustrates another embodiment of a catheter including a balloon for pushing needles from the catheter outwardly into the artery wall.

[0020]FIG. 5 illustrates in cross section a modified embodiment of the catheter of FIG. 4 including a short balloon length with a steep proximal balloon wall.

[0021]FIG. 6 illustrates the distal end of a catheter including a helical balloon in accordance with another embodiment of the invention.

[0022]FIG. 7 illustrates a catheter in accordance with the invention in conjunction with a sheath.

DETAILED DESCRIPTION

[0023] Referring to FIGS. 2, 3 and 3′, a catheter 10 in accordance with an embodiment of the invention includes a proximal end 10 p, a distal end 10 d and a centrally located guide wire tube 29 having a lumen 12 for receiving a guide wire 14. Thus, prior to use, an attending physician can route guide wire 14 into the patient and insert catheter 10 over the guide wire to a desired location within the patient's vascular system. Once catheter 10 is in place, guide wire 14 extends through lumen 12 and out of a guide wire control port 16.

[0024] Also within catheter 10 is a drug delivery port 18 for receiving a drug to be injected into the patient. Drug delivery port 18 is connected to a drug delivery lumens 22 a, 22 b. (In one embodiment, not shown, lumens 22 a and 22 b can merge into a single lumen concentrically surrounding guide wire tube 29.)

[0025] Although FIGS. 2, 3, and 3′ illustrate two lumens 22 a, 22 b, other numbers of lumens for delivering drugs can also be used, e.g., between two and four lumens. However, the invention is not limited by the exact number of drug delivery lumens 22.

[0026] A shrink tube 24 approximately 1 to 6 cm from distal end 10 d of catheter 10 binds tubes 27 a, 27 b (surrounding lumens 22 a, 22 b) together. Shrink tube 24 is affixed to tube 27 a, 27 b, but surrounds and can slide along guide wire tube 29. At a distance D1 from shrink tube 24, tubes 27 a, 27 b are sliced around a circumferential portion of approximately 180°, and hollow needles 26 a, 26 b, are inserted into lumens 22 a, 22 b respectively. (The slice formed in tubes 27 a and 27 b can have different shapes. FIGS. 3C and 3D illustrate two embodiments of slices 31 a, 31 b that can be formed in tubes 27 a and 27 b to accommodate needle placement. The slices 31 a, 31 b help create a preferential bending position for tubes 27 a and 27 b and are sized to facilitate needle placement.) Needles 26 a, 26 b can be held in place within lumens 22 a, 22 b, for example, by an appropriate adhesive (e.g. cynoacrylate). Tubes 27 a, 27 b continue distally of needles 26 a, 26 b. Tubes 27 a, 27 b terminate at distal end 10 d of catheter 10, and are bound together and to guide wire tube 29 with second shrink tube 28. (Shrink tube 28 cannot move relative to tube 29.) Needles 26 a, 26 b are typically located half way between shrink tube 28 and shrink tube 24. The very ends 27 a′, 27 b′ of tubes 27 a, 27 b may be open or sealed.

[0027] In one embodiment, shrink tubes 24 and 28 are located at preferential bending positions of tubes 27 a and 27 b. Because tubes 27 a, 27 b are not bound to tube 29 along the entire length of catheter 10, this permits relative motion of portions of tubes 27 a, 27 b and tube 29. (As explained below, during use, moving tubes 27 a and 27 b relative to tube 29 pushes needles 26 outwardly into the artery wall or inwardly towards guide wire tube 29.) The fact that tubes 27 a, 27 b are not rigidly bound to tube 29 by shrink tube 24 facilitates bending of the tubes 27 a, 27 b.

[0028] Referring to FIG. 3, in accordance with the first embodiment of the invention, after catheter 10 is in its proper position within the patient's vascular system, a physician extends needles 26 a, 26 b outwardly (in directions A and B, respectively) by sliding drug delivery port 18 in a forward direction (see arrow C) relative to guide wire control port 16.

[0029] A portion of catheter 10 is shown in greater detail in FIG. 3′. The movement of drug delivery port 18 relative to guide wire control port 16 causes a first body portion of catheter 10 comprising tubes 27 a and 27 b to move relative to a second body portion comprising tube 29. Portions P1, P2 and P3 of tube 27 a and portions P4, P5 and P6 of tube 27 b act as hinges, permitting needles 26 a, 26 b to move outwardly. In this way, needles 26 a, 26 b are pushed away at an angle α from the main axis of catheter 10 and into the artery wall of the patient.

[0030] In other words, during insertion and placement of catheter 10, needles 26 a, 26 b and the portions of tubes 27 a, 27 b connected to needles 26 a, 26 b lie substantially parallel to guide wire 14 (i.e., α=0°). When the needles 26 a, 26 b are deployed, portions P1, P2 serve as axes of rotation for the needles 26 a, 26 b and the portions of tubes 27 a, 27 b connected to needles 26 a, 26 b. Needles 26 a, 26 b are rotationally pushed away such that portions of tubes 27 a, 27 b connected to needles 26 a, 26 b thus form an angle α>0°. When deployed, needles 26 a, 26 b extend outwards from the main body of catheter 10 by a distance D4, thereby contacting the artery wall.

[0031] The attending physician can then inject medication through drug delivery lumens 22 a, 22 b and needles 26 a, 26 b into the wall of the patient's artery. Such medication can be, for example, an anti-inflammatory, anti-restenotic, or anti-thrombotic medication. Thereafter, the physician can retract needles 26 in directions D and E by pulling drug delivery port 18 in a direction F relative to guide wire control port 16. Catheter 10 can then be retracted from the patient.

[0032] In one embodiment, needles 26 a, 26 b are stainless steel, have an inner diameter of 0.002″ to 0.010″ and an outer diameter of 0.005″ to 0.014″, extend a distance D2 (FIG. 3) of 1 to 3 mm outside of tubes 27 a, 27 b, and have a total length of 3 to 8 mm. However, other needle sizes can also be used. Catheter 10 can be designed such that distance D4 is customized to facilitate better deployment into different size arteries, e.g. coronary or peripheral. Needles 26 a, 26 b can be blunt, as shown in FIG. 3, or sharp.

[0033] The distance D3 (FIG. 2) between shrink tube 24 and the point where needles 26 a, 26 b exit from tubes 27 a, 27 b is between 2 to 10 mm. Distances D2 (FIG. 3) and D3 (FIG. 2) are chosen based on the caliber of the artery in which catheter 10 is to be used. The greater the artery caliber, the greater the total distance D2 plus D3. This is done to ensure that needles 26 reach the artery wall when they are outwardly extended.

[0034] In one embodiment, a catheter in accordance with the invention can be the length L1 (FIG. 2) of conventional balloon dilatation catheters, e.g., 40 to 200 cm. The sliding portion of catheter 10 can have a distance L2 (FIG. 2) between 35 and 195 cm. Shrink tube 28 can be a distance D4 (FIG. 2) between 2 and 30 mm from the distal end of catheter 10. However, other lengths and distances can also be used.

[0035] Stiffening mandrels 30 a, 30 b can be provided within lumens 22 a, 22 b of tubes 27 a, 27 b as shown in FIGS. 2, 3, 3′, 3A and 3B. In one embodiment, the distal ends of mandrels 30 a, 30 b (e.g. the distal 1 to 20 mm) can be flatter than the proximal ends of mandrels 30 a, 30 b. Optionally, notches can be formed in stiffening mandrels 30 a and 30 b to facilitate preferential bending at the location of the notches. In another embodiment, the mandrels are a shape memory alloy such as nitinol having a preferential bend formed therein. In lieu of placing mandrels 30 a, 30 b within lumens 22 a, 22 b, stiffening mandrels 30 a, 30 b can be affixed to the exterior of tubes 27 a, 27 b as shown in FIG. 3B.

[0036] The mandrels are typically 0.003″ to 008″ wide. If the mandrels are not within lumens 22 a and 22 b those lumens are typically 0.006″ to 0.016″ wide (i.e. an inner diameter of 0.006″ to 0.016″). If the mandrels are within lumens 22 a and 22 b, lumens 22 a and 22 b are typically 0.009″ to 0.020″ wide.

[0037] Guide wire lumen 12 is typically about 0.010″ to 0.040″ wide depending upon where the catheter is to be used. For coronary artery applications, lumen 12 is about 0.012″ to 0.018″ wide. For peripheral arteries, lumen 12 can be as wide as 0.040″.

[0038]FIG. 4 illustrates an alternative embodiment of the invention in which a catheter 10′ includes a balloon 32 coupled to a balloon inflation lumen 34. Balloon 32 can be constructed in the same manner as a PTCA (percutaneous transluminal coronary angioplasty) balloon. Alternatively, balloon 32 can be doughnut shaped.

[0039] Operation of catheter 10′ is similar to that of catheter 10 shown in FIGS. 2 and 3. A physician first inserts guide wire 14 into the patient, and then advances catheter 10′ over guide wire 14 until hollow needles 26 a, 26 b are at an appropriate location. When it is desired to insert needles 26 a, 26 b into the patient's artery wall, a physician injects inflation fluid through a balloon inflation port 35 at the proximal end 10 p′ of catheter 10′ through balloon inflation lumen 34 into balloon 32. Balloon 32 then expands and pushes needles 26 a, 26 b outwardly into the artery wall. In other words, needles 26 a, 26 b are rotated outwardly away from the longitudinal axis of catheter 10′ (Arrow AC in FIG. 4 is parallel to the longitudinal catheter axis. Arrow AN is the longitudinal needle axis.) During this process, the points adjacent where tube 27 a, 27 b contact shrink tube 24 act as a hinge. Drugs can then be injected through drug delivery port 18, single drug delivery lumen 20, lumens 22 a, 22 b and needles 26 a, 26 b. Thereafter, needles 26 a, 26 b are retracted by deflating balloon 32 (i.e., by withdrawing inflation fluid from balloon 32 via balloon inflation lumen 34 and balloon inflation port 35). Catheter 10′ is then withdrawn from the patient. Balloon 32 is typically affixed to tubes 27 a, 27 b at points 32 a, 32 b with an adhesive such as epoxy. (Alternatively, balloon 32 can be affixed to tubes 27 a, 27 b by other methods, such as welding.) Thus, when balloon 32 is deflated and contracts, it rotationally pulls needles 26 inwardly and substantially parallel to the longitudinal catheter axis AC so that needles 26 will not drag along the artery wall when the catheter 10′ is retracted. (In other words, the longitudinal needle axes AN are rotated to be substantially parallel to the longitudinal catheter axis AC.) Although not shown in FIG. 4, tubes 27 a, 27 b can include mandrels 30 a, 30 b to enhance their stiffness, as described above with respect to FIGS. 2, 3, 3A, and 3B.

[0040] Balloon 32 can be shaped like a conventional dilatation catheter balloon (e.g. the same length and profile). Alternatively, balloon 32 may be shorter than a conventional dilatation catheter. In one embodiment, balloon 32 has a length L3 between 3 and 10 mm.

[0041] As can be seen, in the embodiment of FIG. 4, the proximal portion 10 p′ of catheter 10′ includes a single drug delivery lumen 20 which divides into two (or more) lumens 22 a, 22 b. In the embodiment shown in FIG. 4E, the distal end 10 d′ of catheter 10′ which includes shrink tube 28 (as shown in FIG. 4), is not included.

[0042]FIGS. 4A, 4B, and 4C illustrate in cross section portions of catheter 10′ along lines A-A, B-B, and C-C, respectively. FIG. 4A shows single drug delivery lumen 20, balloon inflation lumen 34, guide wire lumen 12, and guide wire 14. FIG. 4B shows a cross sectional portion of catheter 10′ after single drug delivery lumen 20 has divided into two drug delivery lumens 22 a, 22 b surrounded by tubes 27 a, 27 b. Finally, FIG. 4C illustrates a cross-sectional view of catheter 10′ along line C-C, with inflated balloon 32 pushing tubes 27 a, 27 b in an angle away from the longitudinal axis of catheter 10′. While FIGS. 4, 4A, 4B, and 4C illustrate a single drug delivery lumens 20, in other embodiments a single drug delivery lumens 20 is not used, and lumens 22 a, 22 b extend to drug delivery port 18.

[0043] As with the embodiment of FIG. 3, the length of the portion of tubes 27 a, 27 b distal to shrink tube 24 can vary. In one embodiment, when needles 26 a, 26 b are in their extended position, they only extend a short distance past the top of balloon 32. In other embodiments, needles 26 a, 26 b can extend a longer distance past the top of balloon 32.

[0044]FIG. 5 illustrates a catheter similar to that of FIG. 4 except that a balloon 32 has a short length. When balloon 32 is inflated, proximal end 32′ of balloon 32 forms a steep step. Needles 26 a, 26 b extend only a very short distance beyond surface 32″ of balloon 32, and are deployed at a near-perpendicular angle with respect to the longitudinal catheter axis in FIG. 5. However, when balloon 32 is deflated, needles 26 a, 26 b are brought to an angle parallel or substantially parallel to the longitudinal catheter axis.

[0045] In FIGS. 4, 4E, and 5, balloon 32 is substantially cylindrical. However, FIG. 4D illustrates in cross section along lines C-C an embodiment of a catheter comprising a balloon 33 which, when inflated, has a clover-like cross section including large wide sections 33 a and narrow sections 33 b. Narrow sections 33 b advantageously permit blood to perfuse past balloon 33 when the catheter is being used and balloon 33 is inflated.

[0046]FIG. 4D shows four tubes 27 instead of two tubes 27 a, 27 b. However, as mentioned above, different numbers of tubes 27 can be used.

[0047] In lieu of the balloon shapes shown in FIGS. 4, 5, and 4D, a helical balloon 35 as shown in FIG. 6 can be employed. The helical shape of balloon 35 facilitates blood perfusion past balloon 35 during use.

[0048] In the above embodiments, the catheter in accordance with the present invention may be used in conjunction with a thin cylindrical sheath 40. FIG. 7 shows catheter 10 of FIG. 2 used in conjunction with a sheath 40 that may be used to surround a portion of catheter 10 to cover needles 26 a, 26 b (and balloon 32, 33, or 36, in the case of an embodiment including a balloon 32, 33, or 36). Sheath 40 keeps needles 26 a, 26 b close to the catheter body, thereby ensuring a low profile, and ensuring that needles 26 a, 26 b stay aligned with the longitudinal axis of catheter 10. When catheter 10 is inserted into the patient's blood vessel at the desired position, sheath 40 extends proximally out of the patient's blood vessel so that the physician can manipulate the sheath 40. A sheath removal handle 42 is affixed to the proximal end of sheath 40. Sheath 40 may be pulled back once the catheter 10 is at a desired position before extending needles 26 a, 26 b and delivering the drug or medication. After use, sheath 40 can be advanced in the distal direction to again cover needles 26 a, 26 b prior to retracting the catheter 10.

[0049] In the above-described embodiments, various structures in the catheter 10 can be formed from radiopaque materials so that the position of catheter 10 may be easily observed during use. For example, the needles 26 a, 26 b may be radiopaque. This can be accomplished, e.g., by plating needles 26 a, 26 b with or constructing needles 26 a, 26 b from a radiopaque material such as titanium or tungsten. Alternatively, radiopaque materials may be placed on the catheter near needles 26 a, 26 b or preferential bending points P1 to P6. Alternatively, radiopaque materials may be placed on the balloon 32, 33, 36.

[0050] The above-described embodiment incorporates shrink tubing, e.g., shrink tubes 24 and 28, to hold various tubes of the catheter 10 together. In lieu of, or in addition to such shrink tubing, the various catheter tubes can be held together by other means, e.g., adhesive heat fusing. Alternatively, the tubes can be coextruded together and then separated by cutting at those locations where the tubes must be permitted to slide relative to one another.

[0051] A catheter 10 in accordance with the invention has numerous advantages:

[0052] 1) The catheter 10 permits blood perfusion (i.e. blood flow around the catheter 10), enabling the catheter 10 to remain within the blood vessel for as long as deemed necessary by the attending physician. This is because the catheter 10 does not block the entire artery lumen even when needles 26 a, 26 b are extended outwardly.

[0053] 2) The catheter 10 is typically very flexible, permitting access to distal, tortuous arteries. The reason for this is that the stiff portion of the catheter 10 (the portion of the length along which needles 26 a, 26 b extend) is very small.

[0054] 3) While the catheter is being positioned, needles 26 a, 26 b lie in the axial direction of catheter 10 substantially parallel to the longitudinal axis AC of catheter 10, thereby minimizing the profile of the catheter 10 and minimizing the chance of injury to the artery.

[0055] While the invention has been described with regard to specific embodiments, those skilled in the art will recognize that changes can be made in form and detail without departing from the spirit and scope of the invention. For example, the material from which the catheter is made can be any extruded polymer or metal, including shape memory metals or a combination thereof. Also, although the embodiments of FIGS. 2 to 7 contain a guide wire lumen 12, and are used in conjunction with a guide wire 14, other embodiments are not used in conjunction with a guide wire 14. In alternative embodiments, a guide wire 14 is not used, and the space which would otherwise be occupied by guide wire lumen 12 is sealed.

[0056] In yet another embodiment, guide wire lumen 12 does not extend the entire length of catheter 10. Instead, guide wire lumen 12 terminates between 1 and 35 cm from distal end 10 d of catheter 10, and guide wire 14 extends through only the distal 1 to 35 cm of catheter 10. This facilitates rapid exchange of catheter 10 over guide wire 14.

[0057] In yet another embodiment, the catheter can contain other lumens for performing other functions. For example, one can place balloons proximal to shrink tube 24 and distal to shrink tube 28 to prevent medication from diffusing away from the injection site.

[0058] Needles 26 a, 26 b can extend greater or lesser distances D2 past tubes 27 a, 27 b. Also, in some embodiments, tubes 27 a, 27 b and needles 26 a, 26 b can be extended at angles closer to or further from right angles than illustrated in FIGS. 3 to 6. The angle at which tubes 27 a, 27 b and needles 26 a, 26 b are extended is typically between 45 and 100°.

[0059] In some embodiments, the catheter is used in vessels other than arteries. Accordingly, all such changes come within the invention. 

I claim:
 1. A catheter for delivering a drug to a location within a patient, comprising: a tube extending from a proximal end to a distal end along an axis and having a first lumen for receiving said drug, said first lumen extending from the proximal end of said tube to an injection port; and a mechanism for angularly pushing said injection port away from the axis of the tube.
 2. Catheter of claim 1 wherein said injection port comprises a needle.
 3. Catheter of claim 1 wherein the tube includes a second balloon lumen and said mechanism comprises a balloon coupled to the balloon lumen, inflation of the balloon pushing said injection port outwardly away from said tube.
 4. Catheter of claim 1 wherein said tube comprises a first body portion which slides relative to a second body portion, said injection port being mechanically coupled to both said first and second body portions such that when said first body portion is moved in a first direction relative to said second body portion, said injection port is pushed outwardly toward said artery wall.
 5. Catheter of claim 4 wherein said first body portion comprises a guide wire tube and said second body portion comprises a drug delivery tube, said guide wire tube and said drug delivery tube extending out of a patient during use so that said guide wire tube and drug delivery tube can be manipulated by a physician.
 6. Catheter of claim 2 wherein said injection port is radiopaque.
 7. Catheter of claim 1 wherein said mechanism comprises a balloon coupled to a balloon lumen, and a radiopaque marker is provided on said balloon.
 8. Catheter of claim 1 wherein the tube includes a second lumen called a balloon lumen and said mechanism comprises a balloon coupled to the balloon lumen, and a radiopaque marker is formed on said catheter proximate to said balloon.
 9. Catheter of claim 1 wherein radiopaque marker is provided on said tube at a preferential bending point where said injection port bends away from said axis.
 10. Catheter of claim 1 further comprising a stiffening mandrel extending through said drug delivery tube.
 11. Catheter of claim 1 wherein said first lumen extends within a drug delivering tube, and a stiffening mandrel extends along the exterior of said drug delivery tube.
 12. Catheter of claim 1 further comprising a sheath surrounding said tube to insure that said injection port does not drag along a patient's artery wall when said tube is being positioned within the patient.
 13. Catheter of claim 1 wherein said mechanism is a helical-shaped balloon.
 14. Catheter of claim 1 wherein said mechanism is a balloon having wide and narrow regions to permit blood to perfuse past said balloon when said balloon is inflated.
 15. A catheter for delivering a drug to a location within a patient comprising: a tube extending from a proximal end to a distal end along an axis and having a first lumen for receiving said drug, said first lumen extending from the proximal end of said tube to an injection port; and a mechanism for rotating said injection port away from the axis of the catheter.
 16. Method for delivering medication to a patient comprising the steps of: inserting a catheter into a patient, said catheter comprising a catheter body, a drug delivery lumen within the catheter body, and an injection port in communication with said drug delivery lumen; angularly extending the injection port away from the catheter axis toward or into the patient's artery wall; and injecting medication into the patient through the drug delivery lumen and said injection port.
 17. Method of claim 16 wherein said injection port is a needle.
 18. Method of claim 16 further comprising the steps of: moving said injection port toward an angle parallel with the axis of said catheter after said step of injecting; and retracting said catheter.
 19. Method of claim 16 wherein said step of extending the injection port at an angle away from the catheter axis is performed by inflating a balloon.
 20. Method of claim 16 wherein said step of extending the injection port at an angle away from the catheter axis is performed by moving a first portion of the proximal end of said catheter relative to a second portion of the proximal end of said catheter. 